Diabetic foot – what can we learn from leprosy? Legacy of Dr Paul W. Brand

Boulton, Andrew J.M.

doi:10.1002/dmrr.2230

Cited by 37 publications

(15 citation statements)

References 20 publications

(22 reference statements)

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“…Lesions found in armadillo in this experiment may suggest to nerve damage subsequent to sensitivity loss caused by the etiological agent of leprosy, since they are animals that have a habit of underground digging in search of their food, but the injuries are inconclusive to diagnosis. Similar lesions can be found in the humans foots diagnosed with leprosy and experiencing metabolic diseases, such as diabetes (Boulton, 2012).…”

Section: Resultssupporting

confidence: 64%

Hepatic steatosis in six-banded armadillo (Euphractus sexcinctus Linnaeus, 1758)

et al. 2018

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The six-banded armadillo (Euphractus sexcinctus) stands out among wild mammals due to the rare occurrence of spontaneous metabolic diseases. When altered, the liver, which is important in metabolism, may trigger a dysfunctional cascade, leading to hepatic steatosis. Here we describe a case of hepatic steatosis in a six-banded armadillo living in captivity. The female specimen was captured and donated to the Federal University of Piaui under SISBIO authorization nº53303. The animal was first referred for a veterinary clinical evaluation, and then euthanized following the ethical standards of the Federal Council of Veterinary Medicine. At the start of the dissection, the abdominal cavity was accessed and sections of all ex situ liver lobes, spleen and mandibular lymph node were subjected to routine histological processing; the results were photo documented. The anatomic and histopathological analysis confirmed the diagnosis of hepatic steatosis, which we propose is related to an infectious process as a result of the changes observed in the organs of the lymphoid system. This report of fatty liver disease in armadillo suggests an acute infectious process with lymphoid system involvement. Keywords: Euphractus sexcinctus, infectious, liver, six-banded armadillo, steatosis. Esteatose hepática em tatu-peba (Euphractus sexcinctus Linnaeus, 1758)Resumo: O tatu-verdadeiro (Euphractus sexcinctus) se destaca entre os mamíferos selvagens devido à rara ocorrência de doenças metabólicas espontâneas. Quando alterado, o fígado, que é importante no metabolismo, pode desencadear uma cascata disfuncional, levando a esteatose hepática. Foi descrito um caso de esteatose hepática em um tatu-verdadeiro vivendo em cativeiro. O espécime feminino foi capturado e doado para a Universidade Federal do Piauí sob a autorização SISBIO nº53303. O animal foi encaminhado para uma avaliação clínica veterinária e, depois, submetido à eutanásia seguindo os padrões éticos do Conselho Federal de Medicina Veterinária. No início da dissecção, acessou-se a cavidade abdominal e as seções de todos os lóbulos do fígado ex situ, do baço e do linfonodo mandibular foram submetidos ao processamento histológico de rotina. Os resultados foram fotomicrografados e documentados. A análise anatômica e histopatológica confirmou o diagnóstico de esteatose hepática, que está relacionada a um processo infeccioso como resultado das mudanças observadas nos órgãos do sistema linfóide. Este relatório de doença hepática gordurosa no armadillo sugere um processo infeccioso agudo com comprometimento do sistema linfático. Euphractus sexcinctus, infecção, fígado, tatu-verdadeiro, esteatose. Palavras-chaves:

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Section: Resultssupporting

confidence: 64%

Hepatic steatosis in six-banded armadillo (Euphractus sexcinctus Linnaeus, 1758)

et al. 2018

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“…The chronic inflammatory skin disease psoriasis was associated with type 2 diabetes, body mass index and obesity in a study of Danish twins, and the study also suggests the possibility of a common cause or relationship between psoriasis and obesity [ 17 ]. Moreover, diabetes induces severe nerve and vascular disorders, bacterial infection, ulcer, retinopathy [ 18 ]. We clarified the properties and functional characteristics of the skin in women with obesity by objective evaluation and measurement to acquire fundamental knowledge on the association between obesity and skin function.…”

Section: Discussionmentioning

confidence: 99%

Characterization of skin function associated with obesity and specific correlation to local/systemic parameters in American women

Mori

Shiraishi

Epplen³

et al. 2017

Lipids Health Dis

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BackgroundObesity is considered problematic not only as a major cause of diabetes, hypertension, and dyslipidemia, but also as a risk of intractable dermatosis; however influence of obesity on skin function has not been clarified. To clarify the mechanism of obesity-associated skin disorders, we aimed to characterize the skin function of subjects with obesity, and identify possible influencing factors.MethodsComplex analyses including instrumental measurement, biochemical and lipidomics were performed for facial skin and physical evaluation in 93 Caucasian women with obesity (OB) and non-obesity (NOB).ResultsIn OB, imbalance in metabolism of carbohydrate and lipid, autonomic nerve activity, and secreted factors were confirmed. In the skin properties in OB, surface roughness was higher by 70%, the water content was lower by 12%, and changes in the lipid profile of stratum corneum ceramide were observed; in particular, a 7% reduction of [NP]-type ceramide, compared with NOB. Moreover, significant redness accompanied by a 34% increase in skin blood flow was observed in OB. Correlation analysis elucidated that the water content was strongly correlated with local skin indices, such as the ceramide composition, redness, blood flow, and TNFα in the stratum corneum, whereas roughness was correlated with the systemic indices, such as serum insulin, leptin, and IL-6.ConclusionsCharacteristics of obesity-associated skin were (A) reduction of the barrier and moisturizing function accompanied by intercellular lipid imbalance, (B) increased redness accompanied by hemodynamic changes, and (C) surface roughness. It was suggested that each symptom is due to different causes in local and/or systemic physiological impairment related to the autonomic nerve-vascular system, inflammation and insulin resistance.Electronic supplementary materialThe online version of this article (10.1186/s12944-017-0608-1) contains supplementary material, which is available to authorized users.

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“…Sensory loss, foot deformities, repetitive pressures, and skin breakdown are considered to be the key aetiopathogenetic pathways to neuropathic foot lesions in diabetes, as first described by Paul Brand in the mid-20th century, and addressing these issues is today a cornerstone in the management of plantar diabetic foot ulcers. 1 Plantar ulcers are usually localized under the metatarsal heads or plantar surface of the first digit, and constitute 22-25% of all diabetic foot ulcers in large western cohort studies. 2,3 There is a limited number of studies regarding development of new ulcers following healing of a plantar forefoot ulcer, and with no uniform definitions of recurrent and other new ulcers.…”

mentioning

confidence: 99%

Recurrent and other new foot ulcers after healed plantar forefoot diabetic ulcer

Örneholm

Apelqvist

Larsson

et al. 2017

Wound Repair Regeneration

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Diabetic foot ulcer is a serious complication in patients with diabetes. In most outcome studies of this condition, there is a combination of various types of ulcer and ulcer locations. Plantar ulcers are usually localized to the forefoot, and constitute a quarter of all diabetic foot ulcers. There are a limited number of studies regarding development of new ulcers following healing of a plantar forefoot ulcer, and there are no uniform definitions of recurrent and other new ulcers. The aim of this study was to evaluate the outcome of a large cohort of consecutively treated patients with diabetes mellitus and a healed planter forefoot ulcer (n = 617) with regard to development, characteristics, and outcome of recurrent and other new ulcers. Patients were followed consecutively and prospectively with a 2-year follow-up, according to a preset protocol. Out of 617 patients, 250 (41%) did not develop any new ulcer, 262 (42%) developed a new ulcer, 87 (14%) died and 18 (3%) were lost at 2 years following healing of a plantar forefoot ulcer. Thirty-four percent developed other new ulcers (112 on the same foot and 99 on the contralateral foot), whereas 51 patients (8%) developed a recurrent ulcer (at the same site and foot). Of the patients who died within 2 years, 30 patients had developed other new ulcers. The risk of a recurrent ulcer in patients with diabetes and a healed plantar forefoot ulcer was only 8% within 2 years, whereas other new ulcers, on the same foot or on the contralateral foot, was seen in 4 out of 10 patients indicating the need for further preventive measures and surveillance in these patients. We suggest a concise definition for new ulcer to be used in future research.

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Diabetic foot – what can we learn from leprosy? Legacy of Dr Paul W. Brand

Cited by 37 publications

References 20 publications

Hepatic steatosis in six-banded armadillo (Euphractus sexcinctus Linnaeus, 1758)

Hepatic steatosis in six-banded armadillo (Euphractus sexcinctus Linnaeus, 1758)

Characterization of skin function associated with obesity and specific correlation to local/systemic parameters in American women

Recurrent and other new foot ulcers after healed plantar forefoot diabetic ulcer

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